Section 34 in Insurance Regulatory and Development Authority of India (Health Insurance) Regulations, 2016
34. Change of TPAs by Insurers for servicing of Health Insurance Policies.
- a. Where there is a change in the TPA, insurers shall communicate to the policyholders 30 days before giving effect to the change.b. The contact details like helpline numbers, addresses, etc. of the new TPA shall be immediately made available to all the policyholders in case of change of TPA.c. The insurers shall take over all the data in respect of the policies serviced by the earlier TPA within thirty days from the cessation of the services of the TPA and make sure that the same is transferred seamlessly to the newly assigned TPA, if any. No inconvenience or hardship shall be caused to the policyholders as a result of the change. In this regard, the following aspects shall receive special attention:i. Status of cases where pre-authorization has already been issued by existing TPA.ii. Status of cases where claim documents have been submitted to the existing TPA for processing.iii. Status of claims where processing has been completed by the TPA and payment is pending with the insurer.
